There is a knowledge gap on the effect of early childhood deworming on development in low- and middle-income countries. This evidence is important in the critical window of growth and development ...before two years of age.
A randomized controlled trial of the benefit, and optimal timing and frequency, of deworming on development was conducted in Iquitos, Peru. Children were enrolled during routine 12-month growth and development visits and randomly allocated to: (1) deworming at the 12-month visit and placebo at the 18-month visit; (2) placebo at the 12-month visit and deworming at the 18-month visit; (3) deworming at the 12 and 18-month visits; or (4) placebo at the 12 and 18-month visits. The Bayley Scales of Infant Development III was used to assess cognitive, language and motor skills at the 12 and 24-month visits. One-way ANOVA analyses used an intention-to-treat approach.
Between September 2011 and June 2012, 1760 children were enrolled. Attendance at the 24-month visit was 88.8% (
=1563). Raw scores on all subtests increased over 12 months; however, cognitive and expressive language scaled scores decreased. There was no statistically significant benefit of deworming, or effect of timing or frequency, on any of the development scores. Baseline height and weight and maternal education were associated with development scores at 24 months.
After 12 months of follow-up, an overall benefit of deworming on cognition, language or fine motor development was not detected. Additional integrated child and maternal interventions should be considered to prevent developmental deficits in this critical period.
In Peru, 11% of deaths are due to trauma. Iquitos is a large underserved Peruvian city isolated from central resources by its geography. Our objective was to implement a locally driven trauma ...registry to sustainably improve trauma healthcare in this region.
All trauma patients presenting to the main regional referral hospital were included in the trauma registry. A pilot study retrospectively analyzed data from the first two months after implementation.
From March to April 2013, 572 trauma patients were entered into the database. Average age was 26.9 years. Ten percent of patients presented more than 24 hours after injury. Most common mechanisms of injury were falls (25.5%), motor vehicle collisions (23.3%), and blunt assault (10.5%). Interim analysis revealed that 99% of patients were entered into the database. However, documentation of vital signs was poor: 42% of patients had temperature, 26% had oxygen saturation documented. After reporting to registry staff, a significant increase in temperature (42 to 97%, P < 0.001) and oxygen saturation (26 to 92%, P < 0.001) documentation was observed.
A trauma registry is possible to implement in a resource-poor setting. Future efforts will focus on analysis of data to enhance prevention and treatment of injuries in Iquitos.
Fish farming, promoted as a measure of poverty alleviation and a source of nutrition, is associated with increased malaria transmission in the Peruvian Amazon.
The contribution made by fish ponds ...(pisciculture) to malaria transmission in the Peruvian Amazon remains to be confirmed. Recent entomological evidence indicates that
Anopheles darlingi, the main malaria vector in the region, is frequently found in fish ponds along the Iquitos-Nauta road (Loreto, Peru). The aim of this study was to quantify the effect of fish pond density on malaria occurrence.
A retrospective 30-month cohort study was conducted in eight communities along the Iquitos-Nauta road. Malaria incidence was ascertained from malaria registries of the local health post, which consist of data from both active and passive surveillance (247 cases). Fish pond density was measured using an interpreted satellite image and information on potential confounders was collected through interviewer-administered questionnaires.
A total of 1018 individuals from 234 eligible households (90% of the 259 total number of households in the study area) provided complete information on exposures and outcome. Fish pond density was found to be a significant predictor of malaria occurrence (aOR
=
1.23; 95% CI: 1.09–1.38).
The association between fish pond density and malaria suggests that fish ponds contribute to malaria transmission in the region. These results have important implications for the prevention and control of malaria and the development of pisciculture as an important economic activity in Amazonia and beyond.
To assess the effectiveness of a hospital policy change toward delayed cord clamping on infant hemoglobin (Hb) levels and anemia status at 4 and 8 months of age.
A cohort of Peruvian mothers and ...infants, originating from a pre/post study investigating a change in hospital policy from early to delayed cord clamping, was followed until 8 months postpartum. Infant hemoglobin levels and anemia status were measured at 4 and 8 months postpartum.
Following the hospital policy change, adjusted mean infant Hb levels improved by 0.89 gdl(-1) 95% confidence interval (95% CI) 0.57-1.22 and anemia was significantly reduced (aOR = 0.38; 95% CI 0.19-0.78) at 8 months postpartum.
A hospital policy change toward delayed cord clamping is effective in improving Hb levels and the anemia status of 8-month-old infants. Prior to scaling-up this intervention, issues related to training, monitoring, safety, additional long-term benefits and specific local conditions should be investigated.
The objective of this manuscript is to provide selective examples of the work of the Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centre for Research and ...Training in Parasite Epidemiology and Control which contribute to the WHO goal of eliminating neglected tropical diseases by 2030. This PAHO/WHO CC specifically aligns its activities with the Sustainable Development Goals and with the goals outlined in the WHO Road Map for Neglected Tropical Diseases 2021-2030. Its role is to contribute to advancing global action on NTDs, primarily through policy development and knowledge translation. Three important projects have recently been completed: 1. Finalizing the Monitoring and Evaluation Framework for the NTD Road Map (published May 2021; this PAHO/WHO CC was a member of the working group); 2. Developing new guidelines for the preventive chemotherapy of Taenia solium taeniasis (published September 2021; this PAHO/WHO CC was co-Chair; and 3. Formulating a policy brief on deworming for adolescent girls and women of reproductive age (published January 2022; this PAHO/WHO CC is co-lead). These projects are the result of the integration of expertise and experience from multiple partners, including from PAHO and WHO (where both organizations provided key leadership), this PAHO/WHO CC, government ministries, civil society organizations and universities, among others. In conclusion, this PAHO/WHO CC contributes timely guidance to country-led evidence-informed public health policy, to cost-effective program implementation and to the identification of priority research topics--all focused, ultimately, on eliminating NTD-attributable morbidity by 2030. Keywords Parasitic diseases; health surveillance system; women; poverty; child. El objetivo de este articulo es proporcionar ejemplos seleccionados de la labor del centro colaborador de investigacion y capacitacion en epidemiologia y control de parasitos de la Organizacion Panamericana de la Salud/Organizacion Mundial de la Salud (OPS/OMS), que contribuye al objetivo de la OMS de eliminar las enfermedades tropicales desatendidas para el 2030. Este centro colaborador de la OPS/OMS alinea sus actividades especificamente con los Objetivos de Desarrollo Sostenible y con los objetivos descritos en la Hoja de ruta sobre enfermedades tropicales desatendidas 2021-2030 de la OMS. Su funcion es contribuir al avance de las medidas mundiales sobre las enfermedades tropicales desatendidas, principalmente mediante la elaboracion de politicas y la traduccion de conocimiento. Recientemente se han completado tres proyectos importantes: 1) finalizacion del marco de seguimiento y evaluacion de la Hoja de ruta sobre enfermedades tropicales desatendidas (publicado en mayo del 2021; este centro colaborador de la OPS/OMS formo parte del grupo de trabajo); 2) elaboracion de nuevas directrices para la quimioterapia preventiva de la teniasis por Taenia solium (publicado en septiembre del 2021; este centro colaborador fue copresidente); y 3) formulacion de un informe de politicas sobre la desparasitacion de las adolescentes y las mujeres en edad reproductiva (publicado en enero del 2022; este centro colaborador fue coautor). Estos proyectos son el resultado de la integracion del conocimiento y la experiencia de multiples asociados, como la OPS y la OMS (ambas organizaciones ofrecieron un liderazgo clave), este centro colaborador de la OPS/OMS, asi como varios ministerios gubernamentales, organizaciones de la sociedad civil y universidades, entre otros. En conclusion, este centro colaborador de la OPS/OMS ofrece orientaciones oportunas para las politicas de salud publica basadas en la evidencia lideradas por los paises, la ejecucion de programas costo-efectivos y la determinacion de los temas de investigacion prioritarios, todo ello destinado, en ultima instancia, a eliminar la morbilidad atribuible a las enfermedades tropicales desatendidas para el 2030. Palabras claves Enfermedades parasitarias; sistema de vigilancia sanitaria; mujeres; pobreza; nino. O objetivo deste manuscrito e fornecer exemplos seletivos do trabalho do Centro Colaborador de Pesquisa e Treinamento em Epidemiologia e Controle de Parasitos da Organizacao Pan-Americana da Saude/Organizacao Mundial da Saude (OPAS/OMS) que contribuem para a meta da OMS de eliminar ate 2030 as doencas tropicais negligenciadas. Este CC da OPAS/OMS alinha especificamente suas atividades com os Objetivos de Desenvolvimento Sustentavel e com as metas delineadas no Roteiro da OMS para Doencas Tropicais Negligenciadas 2021-2030. Seu papel e contribuir para o avanco da acao global contra doencas tropicais negligenciadas, principalmente por meio do desenvolvimento de politicas e da traducao de conhecimentos. Tres importantes projetos foram concluidos recentemente: 1. Finalizacao da Estrutura de Monitoramento e Avaliacao do Roteiro para as DTN (publicada em maio de 2021--este CC da OPAS/OMS foi membro do grupo de trabalho); 2. Desenvolvimento de novas diretrizes para a quimioprofilaxia da teniase por Taenia solium (publicado em setembro de 2021--este CC da OPAS/OMS foi copresidente); e 3. Formulacao de orientacao para politicas de desparasitacao para adolescentes e mulheres em idade reprodutiva (publicado em janeiro de 2022--este CC da OPAS/OMS foi cogestor). Esses projetos sao o resultado da integracao de conhecimentos e experiencia de multiplos parceiros, incluindo a OPAS e a OMS (onde ambas as organizacoes forneceram lideranca essencial), este CC da OPAS/OMS, ministerios governamentais, organizacoes da sociedade civil e universidades, entre outros. Em suma, este CC da OPAS/OMS contribui com orientacoes oportunas para uma politica de saude publica liderada pelos paises e informada com base em evidencias, para a implementacao de programas com boa relacao custo-beneficio e para a identificacao de topicos prioritarios de pesquisa todos focados, em ultima analise, na eliminacao da morbidade atribuivel as DTN ate 2030. Palavras-chave Doencas parasitarias; sistema de vigilancia sanitaria; mulheres; pobreza; crianca.
Standard indicators are being used worldwide to track progress towards achieving the Millennium Development Goals (MDGs). These are usually at country level and do not accurately reflect ...within-country variability of progress towards the targets. This may lead to lack of attention and under-resourcing of the most vulnerable populations. Therefore, the objective of this study was to compare selected standard MDG indicators at country level and community level in Peru. As MDG indicators we selected: (i) moderate to severe and severe underweight in children under 5 years old; (ii) immunization against measles in 1-year olds; (iii) births attended by skilled health professionals and (iv) youth unemployment. Country-level data for Peru were obtained from United Nations published sources. Community-level data were obtained from a household survey conducted in 2005-2006 in Belén, a community of extreme poverty in the Amazon region. Belén indicators were consistently less favourable than country-level indicators, and indicators even differed between zones of high and low socioeconomic status within Belén itself. Compared to MDG indicators at the national level in Peru, the population of Belén experiences intra-country regional disparities in important health and social outcomes. Improving the coverage and quality of interventions and services in this community is essential. Other vulnerable populations in Peru should also be identified and targeted so that they can benefit from, and ultimately contribute to, progress in achieving the MDGs.
Background. Syphilis infection may potentiate transmission of human immunodeficiency virus (HIV). We sought to determine the extent to which HIV acquisition was associated with syphilis infection ...within an HIV preexposure prophylaxis (PrEP) trial and whether emtricitabine/tenofovir (FTC/TDF) modified that association. Methods. The Preexposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499 HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily FTC/TDF or placebo. Syphilis prevalence at screening and incidence during follow-up were measured. Hazard ratios for the effect of incident syphilis on HIV acquisition were calculated. The effect of FTC/TDF on incident syphilis and HIV acquisition was assessed. Results. Of 2499 individuals, 360 (14.4%) had a positive rapid plasma reagin test at screening; 333 (92.5%) had a positive confirmatory test, which did not differ between the arms (FTC/TDF vs placebo, P = .81). The overall syphilis incidence during the trial was 7.3 cases per 100 person-years. There was no difference in syphilis incidence between the study arms (7.8 cases per 100 person-years for FTC/TDF vs 6.8 cases per 100 person-years for placebo, P = .304). HIV incidence varied by incident syphilis (2.8 cases per 100 person-years for no syphilis vs 8.0 cases per 100 person-years for incident syphilis), reflecting a hazard ratio of 2.6 (95% confidence interval, 1.6–4.4; P < .001). There was no evidence for interaction between randomization to the FTC/TDF arm and incident syphilis on HIV incidence. Conclusions. In HIV-seronegative MSM, syphilis infection was associated with HIV acquisition in this PrEP trial; a syphilis diagnosis should prompt providers to offer PrEP unless otherwise contraindicated.
In this study, 2499 HIV-seronegative men or transgender women who were at high risk for HIV acquisition were enrolled in a trial of daily emtricitabine plus tenofovir versus placebo. Those receiving ...the antiretroviral medication had a 44% reduction in HIV incidence.
A total of 2.7 million new infections with the human immunodeficiency virus (HIV) were diagnosed worldwide in 2008, according to the Joint United Nations Program on HIV/AIDS (UNAIDS). Combination antiretroviral therapy for patients with HIV infection restores health and may decrease the transmission of the virus to uninfected partners.
1
Therapy also decreases mother-to-child transmission.
2
Postexposure chemoprophylaxis is recommended after occupational or nonoccupational exposure to HIV-infected fluids.
3
The use of such chemoprophylaxis requires that people recognize when they might have been exposed to HIV and that they start therapy within 72 hours. Both challenges are substantial limitations to the use of . . .
DSM265 is a novel, long-duration inhibitor of plasmodium dihydroorotate dehydrogenase (DHODH) with excellent selectivity over human DHODH and activity against blood and liver stages of Plasmodium ...falciparum. This study aimed to assess the efficacy of DSM265 in patients with P falciparum or Plasmodium vivax malaria infection.
This proof-of-concept, open-label, phase 2a study was conducted at the Asociación Civil Selva Amazónica in Iquitos, Peru. Patients aged 18–70 years, weighing 45–90 kg, who had clinical malaria (P falciparum or P vivax monoinfection) and fever within the previous 24 h were eligible. Exclusion criteria were clinical or laboratory signs of severe malaria, inability to take oral medicine, and use of other antimalarial treatment in the preceding 14 days. Patients were divided into cohorts of those with P falciparum (cohort a) or P vivax (cohort b) infection. Two initial cohorts received single oral doses of 400 mg DSM265. Patients were followed up for efficacy for 28 days and safety for 35 days. Further cohorts received escalated or de-escalated doses of DSM265, after safety and efficacy assessment of the initial dose. The primary endpoints were the proportion of patients achieving PCR-adjusted adequate clinical and parasitological response (ACPR) by day 14 for patients infected with P falciparum and the proportion of patients achieving a crude cure by day 14 for those infected with P vivax. Cohort success, the criteria for dose escalation, was defined as ACPR (P falciparum) or crude cure (P vivax) in at least 80% of patients in the cohort. The primary analysis was done in the intention-to-treat population (ITT) and the per-protocol population, and safety analyses were done in all patients who received the study drug. This study is registered at ClinicalTrials.gov (NCT02123290).
Between Jan 12, 2015, and Dec 2, 2015, 45 Peruvian patients (24 with P falciparum cohort a and 21 with P vivax cohort b infection) were sequentially enrolled. For patients with P falciparum malaria in the per-protocol population, all 11 (100%) in the 400 mg group and eight (80%) of ten in the 250 mg group achieved ACPR on day 14. In the ITT analysis, 11 (85%) of 13 in the 400 mg group and eight (73%) of 11 in the 250 mg group achieved ACPR at day 14. For the patients with P vivax malaria, the primary endpoint was not met. In the per-protocol analysis, none of four patients who had 400 mg, three (50%) of six who had 600 mg, and one (25%) of four who had 800 mg DSM265 achieved crude cure at day 14. In the ITT analysis, none of five in the 400 mg group, three (33%) of nine in the 600 mg group, and one (14%) of seven in the 800 mg group achieved crude cure at day 14. During the 28-day extended observation of P falciparum patients, a resistance-associated mutation in the gene encoding the DSM265 target DHODH was observed in two of four recurring patients. DSM265 was well tolerated. The most common adverse events were pyrexia (20 44% of 45) and headache (18 40% of 45), which are both common symptoms of malaria, and no patients had any treatment-related serious adverse events or adverse events leading to study discontinuation.
After a single dose of DSM265, P falciparum parasitaemia was rapidly cleared, whereas against P vivax, DSM265 showed less effective clearance kinetics. Its long duration of action provides the potential to prevent recurrence of P falciparum after treatment with a single dose, which should be further assessed in future combination studies.
The Global Health Innovative Technology Fund, the Bill & Melinda Gates Foundation, the National Institutes of Health (R01 AI103058), the Wellcome Trust, and the UK Department of International Development.
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